Overall adequacy of antenatal care in Oman: secondary analysis of national reproductive health survey data, 2008

Despite the good health status of women and children in Oman, there are still some gaps to be filled. This study explored the adequacy of antenatal care [ANC] utilization of Omani ever-married women and the sociodemographic and health service determinants of adequate and sufficient ANC. In a secondary analysis of a national dataset [N=1852 women], the percentages of women who had 4+ ANC visits, attended ANC in the 1st trimester and received care by trained personnel were 96.8%, 74.9% and 99.1% respectively. Overall adequacy of ANC [use and sufficiency of recommended basic services] for the surveyed women was 53.8%. After adjustment of other covariates, being pregnant with the 1st baby was the only significant predictor of overall adequacy of ANC [OR 2.2; 95% Cl: 1.6-3.2]. Greater awareness of the need for adequate ANC is required for mothers with more than one baby

Spina bifida and birth outcome before and after fortification of flour with iron and folic acid in Oman

This paper presents the trend of spina bifida and other neural tube defects in Oman after the nationwide implementation of folate supplementation of pregnant women in 1990 and the fortification of wheat flour with iron and folate in 1996. The annual incidence of spina bifida fluctuated from 2.34 to 4.03 per 1000 deliveries between 1991 and 1996, but fell sharply to 2.11 per 1000 deliveries in 1997, after which the downward trend continued, reaching 0.29 per 1000 deliveries by 2006. The rate of other neural tube defects remained almost constant. The reduction in spina bifida rates in Oman could be linked to the start of flour fortification but not the supplementation programme

Methicillin resistant staphylococcus aureus as a nosocomial pathogen in burn wound infection

Methicillin resistant staphylococcus aureus [MRSA] is important as a nosocomial pathogen and MRSA colonization in the burn unit may lead to increased transmission of MRSA to non burn patients in other wards. Was to determine the prevalence of MRSA among patients with burn wound infection in the Burn Unit in Ain Shams University Hospitals. The study involved fifty patients with infected burn wounds divided into two groups as twenty five outpatients and twenty five inpatients in the Burn Unit of Ain Shams University Hospital. Swabs were taken aseptically from infected wounds for bacteriological examination. The most common bacterial isolate among outpatients group was S. aureus [44%], followed by Ps. aeurginosa [40%], coagulase negative Staphylococci [12%], Proteus mirabilis [4%] and Citrobacter freundii [8%]. While in the inpatients group, Ps. Aeruginosa topped the list infecting 36% of patients, followed by S. aureus [24%], coagulase negative Staphylococci [16%], Klebsiella pneurnoniae [12%], E.coli [12%], Proteus mirabilis [8%] and S. pyogenes [4%]. Concerning MRSA, it was isolated from 20% of the inpatients, accounting for 83% of all isolated S.aureus and emerged as a significant nosocomial pathogen as it was not recovered from any outpatient. MRSA is a significant nosocomial pathogen in the Burn unit of Ain Shams University Hospital. Continuous surveillance of burn wound infection and developing strategies for antimicrobial resistance control is recommended

Prevalence of cytomegalovirus IGG antibody in blood donors

Transfusion transmitted human cytomegalovirus [TT-HCMV] infections has been documented in a wide variety of clinical circumstances and can be the cause of significant morbidity and mortality in immunocompromised patients. This study was designed to investigate the prevalence of cytomegalovirus IgG antibody in 80 blood donors [44 professionals and 36 volunteers]. The seroprevalence was 52.5% in all blood donors. The seroprevalence was insignificant as regards the type of blood donormage, residence history of blood transfusion, and history of surgical operation. Prevention of TT-HCMV infection through the manipulation of blood products either by serologic screening or leukocytes reduction is the preferred approach in the HCMV seronegative recipients

Neonatal screening program in Dakahlia: hypothyroidism in clinically suspected cases

In the line with the priorities of the national health services towards preventive medicine early diagnosis and treatment of CH is emphasized. The aim was to assess thyroid status in clinically suspected cases. Subjects and The present study included two groups, the first is a set of neonates [800] attending the general health units in some villages in Dakahlia complaining of prolonged jaundice, constipation, abdominal distention, chocking and/or umbilical hernia. Neonatal TSH levels in filter paper spots taken from heels were assessed for this group. The second group included 114 infants suspected clinically as congenital hypothyroidism by pediatricians. Serum TSH and T4 were estimated for this second group. In the first group 690 neonates [86.25%] had TSH less than 20 micro IU/ml, 88 neonates [11%] had TSH of between 20 and less than 40 micro IU/ml and 22 [2.75%] has TSH more than 40 micro IU/ml. All neonates [110] with TSH more than 20 micro IU/ml [13.75%] had to be recalled after two weeks for reevaluation by serum TSH and T4 levels estimation. Transient hypothyroidism were detected in 70 cases [8.8%] and their serum T4 and TSH levels two weeks after, were normal. Forty neonates [36.4%] were missed and did not respond to our call. Effect of storage on neonatal TSH levels were evaluated in blood spots collected on preserved filter papers. The results revealed that there were gradual increases in the missed cases as zero when estimated with prolonged period of preservation. The results of the second group: Ninety cases [79%] were euthyroid with normal serum TSH and serum T4,17 cases [15%] were with mild elevated serum TSH [7-20 micro IU/ml] and normal serum T4. 7 cases [6.0%] were with elevated serum TSH [more than 20 micro IU/ml] and low serum T4 [less than 96 nmol/L]. second samples, two weeks after the first revealed normalized serum TSH and T4 in 23/24 case. One case presented with prolonged jaundice was diagnosed as overt congenital hypothyroidism. Prolonged jaundice is the presenting complain among 53/114 infants referred by pediatricians as suspected CH [46.49%]. One case Out of 114 studied infants was detected as true CH, while no case of true CH was detected among the neonatal cases. Serum confirmation tests [TSH and T4 levels] should be done in any infant who is suspected to have congenital hypothyroidism. The study assures the importance of public education and awareness in contributing to the cost effectiveness of screening program using filter paper blood spotting and supports the necessity of the rapid assay of filter paper spots within few days in large common collecting center for screening

effect of the trematode Echinostoma liei and certain non-vector snails as biocontrol agents against infectivity of Schistosoma mansoni larval stages to their hosts under laboratory conditions

The present investigation was carried out to study the effect of the non-medically important parasite Echinostoma liei in the presence of three non-vector snails [Planorbis planorbis, Melanoides tuberculata and Helisoma duryi] on the infectivity of the larval stages of Schistosoma mansoni to Biomphalaria alexandrina and to albino mice [Mus Musculus].The infection rates of Biomphalaria alexandrina exposed to Schistosoma mansoni miracidia in the presence of Planorbis, Melanoides and Helisoma snails at ratios of 1B: 5 non-vector snails were significantly lower being 62.9%, 46.9% and 44.4% versus to 83.7% in control group. Also, there are reduction in mean total numbers of cercariae/snail and duration of shedding specially in the presence of Planorbis and Helisoma snails, while the prepatent periods were elongated by the presence of Planorbis and Melanoides snails. Snails exposed to Echinostoma liei miracidia showed reduction in infection rates in the presence of the three studied non-vector snails and in duration of shedding by the presence of Melanoides and Helisomd snails. Snails exposed to both parasites showed reduction in the infection rate especially in the presence of Melanoides and Helisoma snails. No Biomphalaria snails were infected with both parasites in the groups maintained with H. duryi at ratios of 1B: 3H and 1B: 5H. The lowest total number of schistosome and echinostome cercariae was in the group of 1B: 3M. The presence of non-vector snails with infected Biomphalaria suppressed the infectivity of schistosome cercariae to the experimental mice

Total hip arthroplasty after renal transplantation

This study was performed on 31 cemented total hip arthroplasty in 25 renal transplant recipients. The average follow up was 48 months [range 6-66 months]. Total hip arthroplasty relieved pain and improved function in all patients. The average preoperative Harris hip score was 34 +/- 9.46 points which improved to 94 +/- 4.32 points after surgery. At the end of follow up, there were 64.52% excellent and 35.48% good results, there were no fair or poor results in this study. One case had dislocation, one case with grade II myositis ossificans and two cases with suspected cup loosening. The overall complications rate of this group were parallel to those in young patients who had hip arthroplasty for osteoarthritis. There were no reported complications with the renal allograft either intra or postoperatively

Serum interleukin-6, immunoglobulin-E levels and eosinophil count in children with atopy

The cytokine cascade involved in IgE production has implications in allergic inflammation. For this purpose, changes in IL-6 and IgE levels and eosinophilic count were evaluated in sixty children with atopy. They included thirty patients with atopic dermatitis [AD], and thirty with bronchial asthma [BA]. Twenty age- matched apparently healthy children were chosen as control group. The mean serum IL-6 Level was significantly higher in AD [18.85 +/- 17.79 Pg/ml] and BA [45 +/- 38.79 Pg/ml] than the control group [10.28 +/- 7.02 Pg/ml], [p<0.01 and <0.001 respectively]. Higher values for IgE and eosinophil count were also demonstrated among AD [681.9 +/- 555.79 Iu/ml] and [0.69 +/- 0.5 count x 10[2]/L] and BA [2122.9 +/- 1636.86 Iu/ml] and [0.52 +/- 0.38 count x 10[2]/L] as compared to controls [75 +/- 23.8 Iu/ml] and [0.15 +/- 0.11 count x 10[2]/L], [P<0.001 for both]. In addition, serum IL-6 and IgE values were significantly higher in BA than AD group [P<0.01 and <0.001 respectively]. Correlation studies revealed a highly significant positive correlation between serum IL-6 and IgE in both AD [r = 0.79] and BA [r = 0.76] groups, [P<0.001 for both]. Furthermore, among AD group, IL-6 and IgE levels differed grossly with the degree of severity of the disease. By using Z-score, IgE level was the most sensitive estimated parameter to discriminate AD and BA from control group. IL-6 was the second one in BA, while eosinophilic count was the second discriminative parameter in AD. We concluded that IL-6 may be used a sensitive marker of disease activity, beside its possible role in the pathophysiology of bronchial asthma and atopic dermatitis

Effect of alkaloids and saponins of plant origin on biomphalaria alexandrina snails

Lactate dehydrogenase [LDH] [E.C. 1.1.1.28] and glycogen of Biomphalaria alexandrina, the speceific molluscan intermediate host for Schistosoma mansoni, were measured in snails treated with alkaloids extracted from peganum harmala seeds and saponins extracted from luffa cylindrica seeds. Biochemical and histochemical investigations revealed marked depletion in glycogen. Biochemically, LDH activity increased significantly in the lacltate producing direction. This was confirmed histochemically by an inhibition of the enzyme in the pyruvate producing direction in the hepatopancreas and headfoot muscles. The effects were more pronounced in alkaloid treated snails than those treated with saponins. The results indicate an inhibitory effect of both alkaloids and saponins on the aerobic respiration of B. alexandrina. This in turn could inhibit the host-parasite association and hence combat schistosomiasis. Disturbance of the aerobic pathway and stimulation of anaerobia metabolism may lead to glycogen depletion in the host which is the most important prerequiste for the developing parasite

Genetic, clinical, radiological study of monogenic phakomatoses

The study comprised 29 patients with features suggestive of phakomatoses refered to the Human Genetic Clinic, Medical Research Institute, and Dermatology Department, Faculty of Medicine, Alexandria University. All the patients were subjected to complete genetic history, pedigree analysis, clinical genetic, dermatological examinations, radiological investigations [X-ray, Ultrasonography and CT] and cytogenetic study in some patients. The result revealed that: 19 patients had neurofibromatosis [NF], 17 had NF I, one patient had Cafe au-lait type and the last one had segmental type. NF is the most common type of phakomatoses and is inherited as autosomal dominant. Eight patients had chromosomal instability syndromes [4 had xeroderma pigmentoza, 2 had De Sanctis Cacchione syndrome and 2 had ataxia telangiectasia]. Increased chromosomal breaks among these patients were detected by special technique. Chromosomal instability syndromes are inherited as autosomal recessive. The last 2 female patients were diagnosed as focal dermal hypoplasia syndrome [FDH] which is an X-linked dominant phakomatoses. In phakomatoses regular follow up examination and genetic counseling with emphasis on new symptoms are necessary to allow early intervention, detection of

Umbilical cord blood lead levels in Cairo

The history of dealing with the toxic effects of lead is an outstanding example of how knowledge learned from research has its impact on public health. One of the measures that had the greatest impact on reducing exposure to lead, in Cairo, is the introduction of lead-free gasoline by the Egyptian Government, at the first of July, 1997. The objective of this study is to determine the cord blood lead levels and its related epidemiological risk factors in Cairo. The subject of the study was 300 women classified into 3 groups. Each group comprised 100 women. The first and second groups were from Cairo, before and after reduction of lead from gasoline, respectively. The third group [control] was from El-Aiyat and El-Wasta country sides. This study was carried out in the Departments of Obstetrics of El-Hussein University Hospital, AL-AZHAR University, El-Aiyat and El-Wasta General Hospitals. A simple questionnaire was designed to determine the different epidemiological risk factors. Cord blood samples were collected and submitted for estimation of total lead levels. None of the cord blood lead levels reached beyond the permissible value [< 10 ug/dl], even in the first group. The mean value was significantly higher in the first group [2.380 +/- 2.092 ug/dl], compared to the second and third groups [1.140 +/- 0.153 and 0.923 +/- 1.319 ug/dl], respectively, [P < 0.0001]. A scoring system was suggested to find out the women at risk and the necessity of lead analysis. In conclusion, although the cord blood lead levels were not so high, yet the utmost care of our newborns is mandatory as most of the epidemiological risk factors to lead pollution are avoidable. This was a pilot study and a further longitudinal study is recommended

Minimum effective dose of praziquantel in the treatment of Hymenolepis nana

The present study was designed to investigate the effect of different doses of praziquantel in the treatment of Hymenolepis nana among primary school children to define the minimum effective therapeutic dose. Five dose levels were tried, namely 25, 20, 15, 10 and 5 mg/kg body weight as a single oral dose. The results of this study indicated that 10 mg/kg body weight was the minimum accepted dose against H. nana

Nautral coagulation inhibitors in coronary heart disease [CHD]

Haemostasis may be implicated in the pathogenesis of various thrombotic disease. Assay of natural coagulation inhibitors [AT III and PC] in coronary heart diseases may be informative in such cases. In this work, AT III and PC were assayed for 23 patients with coronary ischaemia and infarction besides 12 controls. A highly significant reduction in AT III had been observed in patient groups which had been attributed to an activated coagulation mechanism with consequent consumption of AT III. On the other hand, a significant increase in PC activity had been observed in both studied groups. This rise may be a body attempt to overcome hypercoagulability in those patients. We recommend a trial to use AT III and recombinant APC as therapeutic lines in patients with coronary heart diseases

Methyl alcohol induced acidosis and retinal changes in rats

The effect of acute methyl alcohol poisoning in male albino rats was investigated. Rats injected intraperitoneally with median lethal [6 ml/kg body weight] and lethal [10 ml/kg body weight] doses of absolute methanol showed a significant decrease in their blood pH values indicating acidosis. Methanol estimation indicated that high concentrations remained in the blood twenty four hours post- injection of the median lethal dose. In addition, microscopic examination of the retina showed edema and considerable damage to the photoreceptors, nerve cells of the inner nuclear layer and ganglion cells, which may result in impairment of vision. It was suggested that rats can be used as experimental models for methanol poisoning and the resulting ocular toxicity studies